NHS Health Checks Pathway &
Standards
Christine Smith
Practice Nurse Lead
Bristol City Council
NHS Health Checks
Standards 1-2
1. Identify the eligible population and offering
an NHS Health Check
2. Consistent approach to non-responders and
those who do not attend their risk assessment
appointment.
Standards 3-5
3. Ensuring a complete health check for those
who accept the offer is undertaken and
recorded.
4. Equipment use.
5. Quality control for point of care testing.
Family History
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Ethnicity (list to choose from)
FH Diabetes
FH of IHD under 60 years old
FH of IHD over 60 years old
FH of Hypertension
FH of CVA/Stroke
Pulse
Looking for indication of Atrial Fibrillation
• Record pulse rate & rhythm for 1 minute.
• If pulse irregular
– Arrange for ECG and GP appointment.
Blood Pressure
• Reading < 140/90
– Normal, no further action
• Reading ≥ 140/90
– Take second reading towards end of consultation
and record lowest reading
• Reading remains ≥140/90
– Take HBA1c or FBG and U&E/Creatinine
– Follow Hypertension guidelines
• Reading ≥ 180/110 discuss with Duty Dr.
Cholesterol
• Take cholesterol reading with Cardio-Chek
machine
• If total cholesterol < 7.5
– Record in template
• If total cholesterol ≥ 7.5
– Record in template
– Arrange for fasting lipid profile and refer to GP
Height/Weight/BMI
• Ethnicity
– Ethnic (Indian, Pakistani, Bangladeshi, Other Asian
or Chinese)
– Non ethnic (other)
• Weight Management Service
– Tier 1
– Tier 2
Ethnicity
• BMI ≥ 25 but < 27.5
– Give dietary advice and dietary leaflet.
• BMI ≥ 27.5
– CHECK HBA1C or Fasting Blood Glucose
– Provide dietary and physical activity advice
– If intervention wanted provide self referral form
for weight management services
Non Ethnic Patients
• BMI ≥ 25 but < 28
– Give dietary advice and dietary leaflet
• BMI ≥ 28
– Give dietary advice and dietary leaflet. If intervention
wanted give self referral form for Tier Weight
Management Service
• BMI ≥ 30
– Check HBA1c or Fasting Blood Glucose
– Provide dietary and activity advice
– If intervention wanted provide self referral form for
Tier Weight Management Service
Weight Management Service
• Tier 1
– Management on Referral provided by Slimming
World and Weight Watchers.
• Eligibility Criteria
– Ready to change
– Body mass index > 28 (Ethnic 27.5)
– Not accessed a slimming club in last 6 months
– No history of an eating disorder
Weight Management Service
• Tier 2
– Specialist Weight Management Service for Adults
• Eligibility Criteria
– Ready to change
– BMI ≥ 30 ( Ethnic 27.5)
– Previous history of trying Tier 1 service
– No history of an eating disorder
Exercise
• GPPAQ (General Practice Physical Activity
Questionnaire)
• Categories
– Active
– Moderately Active
– Moderately Inactive
– Inactive
Exercise
• Assessed as Active
– No further action
• Assessed as moderately active/inactive
– Give exercise advice and patient information leaflet
(Get Active, Stay Active PA9)
• Assessed as inactive
– Give exercise advice and patient information leaflet
– Offer referral to Active Choices (Will require referral
from GP/PN).
Smoking
• Smoker
– If no intervention wanted give smoking cessation
advice and leaflet.
– If intervention wanted refer to smoking cessation
service
• Ex smoker
– Record
• Non smoker
– Record
Alcohol (1)
• Audit C scoring
– Score < 5 = Low risk. No further action. Only ask
first 3 questions.
– Score ≥ 5 = Undertake full audit (Further 7
questions)
– Score 5 to 7 = Lower risk. No further action
– Score 8 to 15 = Increasing risk (Hazardous
drinking). Give brief advice and leaflet (Your
Drinking and You SUB17)
Alcohol (2)
- Score 16 to 19 = Higher risk (Harmful drinking).
Give brief advice and leaflet and referral to GP if
wanted.
- Score 20+ = Possible dependency. Refer to GP. If
GP appointment refused give advice and leaflet
and record that GP referral not wanted.
Dementia
• Only for patients aged 65 to 74 years of age
• Highlight link between cardiovascular disease and
dementia
• Signs and symptoms of dementia
– Forgetfulness, problems planning and carrying out
tasks, feeling confused or trouble controlling moods
or behaviours
• If patient has no concerns give information leaflet
• If patient concerned regarding dementia or
memory provide leaflet and refer to GP
(Dementia HHS33)
Standard 6
6. Ensuring results are communicated effectively
and recorded.
QRISK2
• QRISK2 – Risk of having an MI or Stroke in the
next 10 years
• Risk categories
– 0 to 9% = Low Risk
– 10 to 19% = Moderate Risk
– ≥ 20% = High Risk
• A score of ≥ 10% needs a fasting lipid profile
and referral to GP
Results
• Record results onto ‘Your Results’ leaflet
– Cholesterol
– Blood Pressure
– Physical activity
– BMI
– QRISK2 score
– Smoking
• Goal setting
• Motivational Interviewing
Standards 7-10
7. High quality and timely lifestyle advice given
to all.
8. Additional testing and clinical follow up.
9. Appropriate follow up for all if CVD risk
assessed as 10% and greater.
10. Confidential and timely transfer of patient
identifiable data.